a Group's exposure measures how heavily a group is covered. A group is a collection of members. It is also a measure of the "volume" of the coverage. For example, a group with more members is said to have more exposure than a group with less number of members. A group that have members for a longer period of time than a group with only a month or two is said to have more exposure. Such a measure of "volume' or "weight" is quantified using a term called "Exposure".
Because "Exposure" is quantified, it has to have units. The units of Exposure are the "contract months". If a groups exposure is 200 contract months, that means there are perphaps 20 members (active contracts) covered for 10 months. The word "contract" stand for a working employee that is covered under a medical contract. This number does not include the dependents of that employee.
Another dimension to the exposure is that it is measured on a per tier basis. The dependents of a covered employee based on their coverage is organized into tiers. For example the tiers could be: Employee only, Employee and Spouse, Employee and 1 child, Employee and all children. The contract months are measured for each of these configuration resulting in exposure for each tier during that contract period (usually 1 year).
This is an acronym for Third Party Administrator
Flexible spending account. The process by which tax exempted money from participant is used for his health care expenses
satya - Tue Oct 23 2012 13:51:31 GMT-0400 (Eastern Daylight Time)
TPL: Third Party Liability
if you have more than one insurance, how much does the other insurance liable for the claims submitted.
satya - Tue Oct 23 2012 13:52:29 GMT-0400 (Eastern Daylight Time)
COB: Coordination of Benefits
if you have more than one insurance how do you coordinate the paying for claims for the benefits that are sold
satya - Tue Oct 23 2012 13:53:03 GMT-0400 (Eastern Daylight Time)
GL: General Ledger
GL: General Ledger
satya - Tue Oct 23 2012 13:55:02 GMT-0400 (Eastern Daylight Time)
GHP: Group Health Plan
Insurance you have through a company or a group as opposed your own insurance such as medicare, medicaid or a health insurance you bought for yourself and your family (individual)
satya - Tue Oct 23 2012 14:29:51 GMT-0400 (Eastern Daylight Time)
GC: Group Capitation
Practice of paying physicians per member per year or per month irrespective of if they see patients or not